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Neurological soft signs in primary headache patients
L Tremolizzo1, S Ferrario1, A Pellegrini1
1Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
Neuroscience Letters
|April 8, 2015
Summary
Neurological soft signs (NSS) are elevated in episodic tension-type headache and migraine patients, indicating minor brain circuit alterations. These signs may help identify headache patients with comorbidities or brain anomalies for tailored treatments.
Area of Science:
- Neuroscience
- Neurology
- Psychiatry
Background:
- Neurological soft signs (NSS) are subtle anomalies not detected by standard neurological exams.
- NSS are associated with minor brain circuit alterations, particularly in the cerebellar-thalamic-prefrontal network.
- Primary headache disorders, like migraine and tension-type headache, often present with psychiatric comorbidities.
Purpose of the Study:
- To assess NSS in patients with episodic frequent migraine (MH) and episodic tension-type headache (ETTH).
- To compare NSS levels in headache patients against healthy controls.
- To explore the relationship between NSS, clinical headache characteristics, and brain MRI findings, including white matter hyperintensities (WMH).
Main Methods:
- An exploratory study involving 20 MH outpatients, 10 ETTH outpatients, and 30 matched healthy controls.
- Assessment of NSS using the Heidelberg scale.
- Collection of clinical headache characteristics and brain MRI data for all participants.
Main Results:
- NSS were significantly increased in both ETTH (∼70%) and MH (∼90%) patients compared to controls (p<0.001).
- The increased NSS in headache patients remained significant after controlling for age and education.
- Headache patients with white matter hyperintensities (WMH) on brain MRI exhibited higher NSS scores than controls and patients without WMH.
Conclusions:
- NSS are elevated in primary headache disorders, suggesting underlying minor brain anomalies.
- NSS can help identify a subset of headache patients with shared comorbidities or minimal brain alterations.
- These findings suggest the potential for tailored prophylactic treatment strategies for specific headache patient groups identified by NSS.
